The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 12)

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 327: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 12)

Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 12) But first, here’s that sweet sweet bumper music

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together. If you haven’t yet I have a few things you should do.

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You have found yourself smack dab in the middle of Episode #327 Now if you missed last week’s episode, we talked about SMT and Cauda Equine and SMT and Discectomy. Make sure you don’t miss that info. Keep up with the class. On the personal end of things…..

I recently returned from my Mastermind trip out to Nashville and we had a big time. We had a company called Vision Spark come to speak with us about hiring staff the proper way and it was enlightening. I think the whole group got lots of great ideas out of it.

Mastermind leader, Kevin Christie, shared some techniques and software he’s been using to create training modules and manuals for his office staff onboarding when necessary. Really cool stuff. Mastermind members Emma Minx and Jonathan Saigh from Wisconsin shared a new place to find qualified hires instead of Indeed. Which is outstanding because, honestly, Indeed has trashed the hiring process. In lots of ways but since Indeed came about, we have had them not show up for interviews around 50% of the time, we have hired candidates no less than 4 times where they accepted our job, gave their 2-weeks notice at their other job and after waiting out that 2 weeks….they never showed up at our job so we had to start over…. Indeed is garbage so that’s nice to have another technique or pond to fish in.

I got to hang out with Mike Massey for a while, which is always a pleasure. We talked about practice, bee keeping, music, and all of the worldly problems that we felt we could solve in one night.

Mastermind Dr. Anthony Houssain out in Huntsville Alabama shared that he’s saved over $1000 a month by changing to his current credit card processor. So that will be nice to get going I got our new billing and collections company from members Gerry Mitchell and Curt Kippenberger.

We all went out and acted like teenagers on Broadway in Nashville for a few nights. I watched Lindsey Mumma dance and sing to Shoop by Salt n Pepa and talked to Tiffany and Tyler Armstrong about decompression.

We’re looking forward to visiting Doug Krebs’s practice when we go out to Chicago for the next mastermind meeting.

My point being; get you a mastermind. If you don’t know where to find one, Dr. Christie still has some room in his Western Mastermind. Mine is the Eastern Mastermind and my group is full but still room in the Western group. If you’re interested, email Dr. Christie at [e-mail] and start the conversation.

Item #1 We are continuing our series on why the hell the WHO has recommended spinal manipulative therapy at only very low confidence. I’m calling BS so I went and found all of the research they cited for this hullabaloo and going through it one at a time with you all here on the podcast.

The first one is called, “Osteopathic manipulative treatment in obese patients with chronic low back pain: a pilot study” by Vismara et. Al. and published in Manual Therapy in 2012. And why the hell are they basing their opinion and recommendation of SMT on a pilot study? This is the whole point of it. For better or worse, don’t we have better research available to base the whole profession on?

The answer is yes….yes we do.

Remember, the citations can be found at chiropracticforward.com under this episode.

Luca Vismara, Veronica Cimolin, Francesco Menegoni, Fabio Zaina, Manuela Galli, Stefano Negrini, Valentina Villa, Paolo Capodaglio, Osteopathic manipulative treatment in obese patients with chronic low back pain: A pilot study, Manual Therapy, Volume 17, Issue 5, 2012, Pages 451-455, ISSN 1356-689X, https://doi.org/10.1016/j.math.2012.05.002.

(https://www.sciencedirect.com/science/article/pii/S1356689X12000987)

Why They Did It Obesity is frequently associated with various musculoskeletal disorders including chronic low back pain (cLBP). Osteopathy is a discipline emphasizing the conservative treatment of the disease in an holistic vision. We designed a randomized controlled study to investigate whether Osteopathic Manipulative Treatment (OMT) combined with specific exercises (SE) is more effective than specific exercises alone in obese patients with cLBP.

How They Did It Nineteen obese females with cLBP, randomized into 2 groups: 1. specific exercises + Osteopathic Manipulative Treatment and 2. specific exercises alone were studied during the forward flexion of the spine using an optoelectronic system. A biomechanical model was developed in order to analyse kinematics and define angles of clinical interest.

What They Found Significant effects on kinematics were reported only for Osteopathic Manipulative Treatment + specific exercises with an improvement in thoracic range of motion of nearly 20%. All scores of the clinical scales used improved significantly. The greatest improvements occurred in the Osteopathic Manipulative Treatment + specific exercises group.

Wrap It Up Combined rehabilitation treatment including Osteopathic Manipulative Treatment (Osteopathic Manipulative Treatment + specific exercises) showed to be effective in improving biomechanical parameters of the thoracic spine in obese patients with cLBP. Such results are to be attributed to Osteopathic Manipulative Treatment, since they were not evident in the specific exercises group. We also observed a reduction of disability and pain. The clinical results should be considered preliminary due to the small sample size.

Item #2 The last one this week is called, “Pain, Range Of Motion And Back Strength In Chronic Mechanical Low Back Pain Before and After Lumbar Mobilixation”” by Verma et al published in International Journal Of Physiotherapy and Research in 2013.

Verma, Y., & Goyal, M. (2013). PAIN, RANGE OF MOTION AND BACK STRENGTH IN CHRONIC MECHANICAL LOW BACK PAIN BEFORE & AFTER LUMBAR MOBILISATION.

Both papers we are covering are from 2012 and 2013 so 11 and 12 years old and one of them is a pilot study. Just seeing if you all are keeping score here.

Why They Did It Joint mobilisations in the spine are used as an integral part of the treatment and rehabilitation to alleviate pain and reduce stiffness. Mobilisation has also been used to improve muscle strength as described in the literature. However, there is dearth of data exploring the effect of mobilisation on muscle strength in CLBP. Purpose:To investigate the effects of lumbar mobilisation on pain, range of motion and back strength chronic mechanical low back pain patients.

How They Did It Thirty subjects with chronic back pain participated in the randomized clinical trial. The effects of lumbar mobilisation & exercises were compared with the exercises alone. Pain levels were measured using visual analog scale, lumbar extension range of motion using modified Schobers test and strength by back-leg-chest dynamometer. Measurements were done before & after 2 and 4 weeks respectively.

What They Found A significantly greater improvement in pain, ROM, and strength after 4 weeks in experimental group than the control group.

Wrap It Up This study therefore provides experimental evidence to support the use of lumbar mobilization along with the exercises for the management of patients with chronic mechanical low back pain, who responded favorably to the intervention.

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

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Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

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